Clinical research in risk stratification in cardiology requires sophisticated insight into clinical issues, as well as expertise in quantitative analytic methods. This combination may best be achieved by physician-scientists who excel at the interface of cardiology with epidemiology/biostatistics. The purpose of this proposal is to develop and refine the applicant's methodologic skills in epidemiology and biostatistics, with special emphasis on the application of newer multivariate analytic techniques, and clinical investigative skills, with special emphasis on ischemic heart disease and ambulatory monitoring, in the development of a productive career in clinical research. These two sets of skills will be applied to two projects to study the evaluation and management of patients with asymptomatic myocardial ischemia as detected by ambulatory electrocardiographic monitoring. The first study will attempt to determine if the detection and reduction of asymptomatic myocardial ischemia reduces the risk of adverse cardiac outcome in patients with coronary artery disease and positive exercise tests. The second study will attempt to. determine if the detection and reduction of asymptomatic myocardial ischemia improves the outcome of patients undergoing peripheral vascular surgery.